Treatment of Poison Ivy with Short-Burst Steroids
A 5-day short burst of oral corticosteroids can be used to treat poison ivy dermatitis, but a longer course (15 days with taper) may be more effective in preventing the need for additional medications. 1, 2
Treatment Options Based on Severity
Mild to Moderate Cases
- First-line therapy: High-potency topical corticosteroids
- Apply twice daily to affected areas for up to 2 weeks
- Examples: clobetasol propionate 0.05% or betamethasone dipropionate 0.05% 1
- For face/intertriginous areas: Use lower potency steroids (hydrocortisone 2.5%) for maximum 7 days
Extensive Disease (>30% Body Surface Area)
- Systemic therapy indicated: Oral prednisone 0.5-1 mg/kg/day 1
- Timing matters: Most effective when started within 48 hours of rash onset
- Duration options:
- Short course: 40 mg daily for 5 days
- Long course: 5-day regimen followed by taper (30 mg daily for 2 days, 20 mg daily for 2 days, 10 mg daily for 2 days, and 5 mg daily for 4 days) for a total of 15 days
Evidence for Short vs. Long Course
A randomized controlled trial comparing 5-day vs. 15-day tapered prednisone regimens found:
- No significant difference in adherence rates, rash return, or time to improvement
- Key advantage of longer course: Patients were significantly less likely to need additional medications (22.7% vs. 55.6%, NNT=3) 2
- This suggests the longer course may be more effective at fully resolving symptoms
Adjunctive Treatments
- Immediate washing with soap and water (can remove up to 100% of urushiol if done immediately)
- Cool compresses and oatmeal baths for symptomatic relief
- Oral antihistamines for pruritus (limited efficacy as primary treatment) 1
Common Pitfalls to Avoid
- Undertreatment: Despite recommendations for 14+ days of treatment, most emergency clinicians prescribe shorter durations, which is associated with increased return visits 3
- Overuse of topical steroids: Do not exceed 2 weeks of continuous application to avoid skin atrophy 1
- Inappropriate steroid potency: Using high-potency steroids on face/intertriginous areas can cause rapid atrophy
- Delayed treatment: Systemic steroids are most effective when started within 48 hours of rash onset
When to Seek Further Care
- Systemic involvement (fever, extensive blistering)
- Involvement of eyes, mouth, or genitals
- Failure to respond to initial treatment
- History of severe reactions to poison ivy
For most cases of poison ivy dermatitis, a 5-day course of steroids may be sufficient, but evidence suggests that a longer tapered course (15 days) reduces the need for additional medications and may prevent return visits for persistent symptoms.